The Impact of the 2019 European Guideline for Cardiovascular Risk Management: A Cross-Sectional Study in General Practice
Abstract
:1. Introduction
2. Methods
2.1. Study Design, Setting, and Participants
2.2. Implementation of CV Risk Classification
2.3. Database Query and Variables
2.4. Data Analysis
3. Results
3.1. Characteristics of Patients
3.2. Impact of Guideline Update on Risk Classification and LDL-C Target Values
3.3. Impact of Guideline Update on LDL-C Target Value Achievement
3.4. Lipid-Lowering Treatment in LDL-C Target Non-Achievers
4. Discussion
Strength and Limitations
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
Data Sharing
References
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2016 Guideline | ||||
---|---|---|---|---|
Patient Characteristics | Low Risk | Moderate Risk | High Risk | Very High Risk |
(n = 9461) | (n = 21,138) | (n = 29,176) | (n = 39,157) | |
Median age (IQR) | 47 (44–51) | 58 (53–63) | 69 (53–81) | 72 (61–81) |
% female | 75.7 | 38.6 | 57.0 | 42.6 |
% with an LDL-C measurement | 9.9 | 16.1 | 19.1 | 36.9 |
median LDL-C (IQR) mmol/L | 3.1 (2.5–3.8) | 3.3 (2.7–4) | 3.0 (2.3–3.9) | 2.3 (1.8–3.1) |
Morbidities | ||||
s % with previous CVD | 0.0 | 0.0 | 0.0 | 27.8 |
% with severe CKD | 0.0 | 0.0 | 0.0 | 10.2 |
% with moderate CKD | 0.0 | 0.0 | 57.9 | 25.1 |
% with diabetes | 0.0 | 0.0 | 23.6 | 74.2 |
% with dyslipidemia | 53.5 | 68.7 | 32.5 | 39.8 |
% with hypertension | 11.7 | 22.3 | 43.4 | 67.2 |
% with obesity | 15.7 | 16.3 | 12.5 | 25.5 |
Lipid-lowering drugs | ||||
% no treatment | 97.6 | 93.3 | 80.0 | 52.2 |
% statin only | 2.1 | 6.0 | 18.3 | 42.7 |
% statin and ezetimibe | 0.18 | 0.46 | 1.37 | 4.52 |
% ezetimibe only | 0.11 | 0.19 | 0.33 | 0.49 |
% statin and PCSK-9 inhibitors | 0.00 | 0.00 | 0.03 | 0.06 |
% PCSK-9 inhibitors only | 0.00 | 0.00 | 0.01 | 0.02 |
2019 Guideline | ||||
Patient Characteristics | Low Risk | Moderate Risk | High Risk | Very High Risk |
(n = 10,094) | (n = 17,583) | (n = 54,876) | (n = 20,798) | |
Median age (IQR) | 48 (44–52) | 58 (53–62) | 68 (56–78) | 74 (66–83) |
% female | 74.8 | 38.9 | 51.8 | 38.7 |
% with an LDL-C measurement | 9.0 | 13.5 | 24.6 | 37.9 |
median LDL-C (IQR) mmol/L | 3.1 (2.5–3.6) | 3.2 (2.6–3.8) | 2.9 (2.1–3.7) | 2.2 (1.7–3) |
Morbidities | ||||
% with previous CVD | 0.0 | 0.0 | 0.0 | 52.4 |
% with severe CKD | 0.0 | 0.0 | 0.0 | 19.1 |
% with moderate CKD | 0.0 | 0.0 | 36.8 | 31.5 |
% with diabetes | 0.0 | 0.0 | 47.9 | 46.4 |
% with dyslipidemia | 52.2 | 67.0 | 38.5 | 48.1 |
% with hypertension | 10.8 | 22.7 | 45.4 | 78.6 |
% with obesity | 14.9 | 16.9 | 15.4 | 29.8 |
Lipid-lowering drugs | ||||
% no treatment | 98.0 | 94.2 | 74.6 | 42.2 |
% statin only | 1.8 | 5.3 | 23.4 | 50.5 |
% statin and ezetimibe | 0.11 | 0.39 | 1.61 | 6.63 |
% ezetimibe only | 0.09 | 0.15 | 0.38 | 0.60 |
% statin and PCSK-9 inhibitors | 0.00 | 0.00 | 0.02 | 0.12 |
% PCSK-9 inhibitors only | 0.00 | 0.01 | 0.01 | 0.04 |
2019 | ||||
---|---|---|---|---|
Patient Characteristics | Low Risk | Moderate Risk | High Risk | Very High Risk |
(n = 475) | (n = 1769) | (n = 11,551) | (n = 6809) | |
Median age (IQR) | 49 (45–53) | 59 (55–63) | 67 (57–76) | 72 (64–79) |
% female | 81.3 | 41.0 | 51.5 | 35.5 |
median LDL-C (IQR) in mmol/L | 3.6 (3.3–4.0) | 3.5 (3.1–4.0) | 3.1 (2.5–3.9) | 2.4 (1.9–3.2) |
Median distance to LDL-C target (IQR) in mmol/L | 0.6 (0.3–1.0) | 0.9 (0.5–1.4) | 1.3 (0.7–2.1) | 1.0 (0.5–1.8) |
Lipid-lowering drugs | ||||
% no treatment | 93.3 | 89.1 | 58.5 | 28.9 |
% statin only | 5.3 | 10.1 | 37.7 | 58.7 |
% statin and ezetimibe | 0.84 | 0.45 | 3.05 | 11.4 |
% ezetimibe only | 0.63 | 0.40 | 0.74 | 0.84 |
% statin and PCSK-9 inhibitors | 0.00 | 0.00 | 0.06 | 0.22 |
% PCSK-9 inhibitors only | 0.00 | 0.00 | 0.02 | 0.07 |
Statin treatment intensity | ||||
% high | 1.5 | 2.3 | 12.0 | 33.8 |
% moderate | 2.9 | 6.9 | 23.7 | 29.9 |
% low | 0.2 | 0.5 | 1.7 | 2.1 |
% missing | 1.5 | 0.9 | 3.3 | 4.4 |
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Meier, R.; Rachamin, Y.; Rosemann, T.; Markun, S. The Impact of the 2019 European Guideline for Cardiovascular Risk Management: A Cross-Sectional Study in General Practice. J. Clin. Med. 2020, 9, 2140. https://doi.org/10.3390/jcm9072140
Meier R, Rachamin Y, Rosemann T, Markun S. The Impact of the 2019 European Guideline for Cardiovascular Risk Management: A Cross-Sectional Study in General Practice. Journal of Clinical Medicine. 2020; 9(7):2140. https://doi.org/10.3390/jcm9072140
Chicago/Turabian StyleMeier, Rahel, Yael Rachamin, Thomas Rosemann, and Stefan Markun. 2020. "The Impact of the 2019 European Guideline for Cardiovascular Risk Management: A Cross-Sectional Study in General Practice" Journal of Clinical Medicine 9, no. 7: 2140. https://doi.org/10.3390/jcm9072140